Corneal Sensitivity as an Ophthalmic Marker of Diabetic Neuropathy

Pritchard, Nicola; Edwards, Katie; Vagenas, Dimitrios; Shahidi, Ayda M.; Sampson, Geoff P.; Russell, Anthony; Malik, Rayaz A.; Efron, Nathan

doi:10.1097/opx.0b013e3181fd6188

Cited by 38 publications

(32 citation statements)

References 29 publications

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“…Such dysfunction could arise from a peripheral neuropathy involving the afferent sensory nerves from the ocular surface affecting corneal sensitivity and the autonomic (efferent) nerves responsible for innervating the tear-component secreting glands and the lacrimal and meibomian glands [35, 40, 41]. This is supported by the current results of reduced corneal sensitivity; however the previously reported association between corneal sensitivity and peripheral neuropathy failed to reach statistical significance in the current study ( r = 0.24, P = 0.08) [42]. Reduced tear secretion has previously been identified in patients with type 2 diabetes relative to healthy controls [8, 11].…”

Section: Resultssupporting

confidence: 83%

Peripheral Neuropathy and Tear Film Dysfunction in Type 1 Diabetes Mellitus

Misra

Patel

McGhee

et al. 2014

Journal of Diabetes Research

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Purpose. To compare tear film metrics in patients with type 1 diabetes mellitus (DM) and healthy controls and investigate the association between peripheral neuropathy and ocular surface quality. Methods. Dry eye symptoms were quantified in 53 patients with type 1 DM and 40 age-matched controls. Ocular examination included tear film lipid layer thickness grading, tear film stability and quantity measurement, and retinal photography. DM individuals additionally underwent a detailed neuropathy assessment. Results. Neither mean age nor dry eye symptom scores differed significantly between the DM and control groups (P = 0.12 and P = 0.33, resp.). Tear lipid thickness (P = 0.02), stability (P < 0.0001), and quantity (P = 0.01) were significantly lower in the DM group. Corneal sensitivity was also reduced in the DM group (P < 0.001) and tear film stability was inversely associated with total neuropathy score (r = −0.29, P = 0.03). Conclusion. The DM group exhibited significantly reduced tear film stability, secretion, and lipid layer quality relative to the age-matched control group. The negative correlation between tear film parameters and total neuropathy score suggests that ocular surface abnormalities occur in parallel with diabetic peripheral neuropathy.

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Section: Resultssupporting

confidence: 83%

Peripheral Neuropathy and Tear Film Dysfunction in Type 1 Diabetes Mellitus

Misra

Patel

McGhee

et al. 2014

Journal of Diabetes Research

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“…It has been demonstrated in both human and animal subjects that diabetes alters the structure of corneal nerves, and this may be an early marker for diabetic PN. 2–6,12,18–25 We propose that a diabetes-induced loss in corneal nerve density will translate into a decrease in cornea sensitivity in response to corneal stimulation through hypertonicity that can be evaluated by capturing and measuring behavioral changes in facial and/or ocular movement. Quantifying these behavioral changes could provide an objective screening tool for detection of PN that can be easily performed during a routine eye examination.…”

Section: Discussionmentioning

confidence: 99%

“…As an alternative, we developed an objective functional test of corneal sensitivity. 6 The method uses hyperosmolar eye drops to activate transient receptor channel-8 receptors (TRPM8) in the cornea, which results in reflex blinking and squinting if the nerves are intact. 7 As diabetic PN develops, damaged corneal nerves lose sensation, which decreases the reflex response to corneal stimulation.…”

mentioning

confidence: 99%

Corneal Sensitivity to Hyperosmolar Eye Drops: A Novel Behavioral Assay to Assess Diabetic Peripheral Neuropathy

Yorek

Davidson

Poolman

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PurposeDiagnosis of peripheral neuropathy (PN), which affects approximately 50% of the diabetic population, is subjective, with many patients seeking a diagnosis only after presenting with symptoms. Recently, in vivo confocal microscopy of subepithelial corneal nerve density has been promoted as a surrogate marker for early detection of PN, but imaging of corneal nerves requires sophisticated instrumentation, expertise in confocal imaging, cooperative patients, and automated analysis tools to derive corneal nerve density. As an alternative, we developed a simple screening method that is based on the sensitivity of corneal nerves to cause reflex eyelid squinting in response to hyperosmolar eye drops.MethodsEyes of control and type 2 diabetic rats were given an eye drop of a 290- to 900-mOsm solution, and the ocular response was video recorded. Other neuropathic end points including nerve conduction velocity and subepithelial cornea nerve density were determined.ResultsMotor and sensory nerve conduction velocity and total nerve fiber length of corneal nerves in the subepithelial layer were significantly decreased in diabetic rats. Applying the hyperosmotic solutions to the ocular surface caused an osmolarity-dependent increase in squinting of the treated eye in control rats. Squinting was almost totally blocked by preapplication of proparacaine or N-(4-tertiarybutylphenyl)-4-(3-chloropyridin-2-yl)tetrahydropyrazine-1(2H)-carbox-amide, a transient receptor potential melastatin-8 channel blocker. Squinting in response to the 900-mOsm solution was significantly reduced in diabetic rats.ConclusionsPreclinical studies show that evaluation of corneal sensitivity may be an alternative method for the early detection of PN and has potential for translation to clinical studies.

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“…It has been suggested that optometrists can use color vision screening to detect changes in early diabetes and may have a role to play in detecting diabetic neuropathy by measuring corneal sensitivity. 98,99 …”

Section: Patient Evaluationmentioning

confidence: 98%

Screening for diabetic retinopathy: the optometrist’s perspective

Aldebasi¹,

Reddy²,

Nair³

et al. 2015

OPTO

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Diabetic retinopathy (DR) is a micro-vascular complication of diabetes affecting nearly all persons with a duration of diabetes of $15 years; and is the most common cause of blindness in the working-age adult population in developed countries. Vision loss results mainly from macular edema, macular capillary nonperfusion, vitreous hemorrhage, and tractional retinal detachment. Timely and appropriate care at early stages of DR can significantly reduce visual loss over time, improve patients' quality of life, and reduce the financial burden associated with the complications of visual impairment. Treatment modalities such as retinal photocoagulation, intraocular injections of pharmacological agents, and vitreo-retinal surgery have been effective in the management of DR. Optometry is a health care profession that is concerned with eyes and related structures, vision, and the visual system. Apart from refraction and visual rehabilitation, optometrists have a wide range of roles to play in DR management by performing new visual acuity tests, detecting DR early using dilated ophthalmoscopy and if required imaging modalities, monitoring disease progression, providing timely follow-up examinations and management which are critical for early diagnosis and intervention, making referral for concurrent care when indicated, and, above all, educating the patient. The optometrist's participation in the shared care of DR management regimen is likely to result in improvement in patient outcomes. This review is aimed at highlighting what primary-care optometrists are doing to manage this sight-threatening disease, what they can and should do to improve their competence in providing eye care to patients with diabetes, and what guidelines they need to follow to improve visual outcomes in the management of DR and diabetes mellitus.

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Corneal Sensitivity as an Ophthalmic Marker of Diabetic Neuropathy

Abstract: NCCE is a sensitive test for the diagnosis of minimal and more advanced diabetic neuropathy and may serve as a useful surrogate marker for diabetic and perhaps other neuropathies.

Cited by 38 publications

References 29 publications

Peripheral Neuropathy and Tear Film Dysfunction in Type 1 Diabetes Mellitus

Peripheral Neuropathy and Tear Film Dysfunction in Type 1 Diabetes Mellitus

Corneal Sensitivity to Hyperosmolar Eye Drops: A Novel Behavioral Assay to Assess Diabetic Peripheral Neuropathy

Screening for diabetic retinopathy: the optometrist’s perspective

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Corneal Sensitivity as an Ophthalmic Marker of Diabetic Neuropathy

Abstract: NCCE is a sensitive test for the diagnosis of minimal and more advanced diabetic neuropathy and may serve as a useful surrogate marker for diabetic and perhaps other neuropathies.

Cited by 38 publications

References 29 publications

Peripheral Neuropathy and Tear Film Dysfunction in Type 1 Diabetes Mellitus

Peripheral Neuropathy and Tear Film Dysfunction in Type 1 Diabetes Mellitus

Corneal Sensitivity to Hyperosmolar Eye Drops: A Novel Behavioral Assay to Assess Diabetic Peripheral Neuropathy

Screening for diabetic retinopathy: the optometrist&rsquo;s perspective

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Screening for diabetic retinopathy: the optometrist’s perspective